Anthony J. Tortolani, MD, FACS, FACC, Cardiac and Thoracic Surgeon and Professor Emeritus of Clinical Cardiothoracic Surgery at Weill Cornell Medical College

Summary

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Becker’s Healthcare Podcast: Dr. Anthony J. Tortolani on the Changing Landscape of Cardiac Care and Ambulatory Surgery Centers

Date: December 22, 2025
Guest: Dr. Anthony J. Tortolani, Cardiac and Thoracic Surgeon, Professor Emeritus, Weill Cornell Medical College
Host: Francesca Matthews

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Overview

This episode features Dr. Anthony J. Tortolani, a renowned cardiac and thoracic surgeon and professor emeritus at Weill Cornell Medical College. Dr. Tortolani draws on his decades of experience developing and managing ambulatory surgery centers (ASCs) to analyze major trends, challenges, and opportunities within healthcare—especially as they relate to cardiac care, artificial intelligence (AI), and the evolving ASC landscape. Throughout this engaging conversation, Dr. Tortolani provides candid insights on clinical innovation, staffing shortages, equity issues in rural medicine, and the critical business pressures facing health systems.

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Key Discussion Points and Insights

Dr. Tortolani’s Background and Experience

• Introduction & Career Highlights (00:31)
  • Spent career as chief of cardiothoracic surgery or department chair, mostly within the Cornell network.
  • Instrumental in building the first ASC at Northwell, converting hospital floors at NY Presbyterian for ambulatory surgery, and developing ASCs across multiple hospitals.
  • Participated in strategic planning, sometimes deciding not to build ASCs when not feasible, giving him a broad perspective.

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Top Trends in Healthcare

1. Worsening Caregiver Shortages (01:48)

“The great concern about not having enough caregivers, primarily anesthesiologists, nurses and anesthesia assistants. That is a real problem that's going to get worse over the next 7 or 8, 10 years unless we increase the number of anesthesiologists for training.”
(Dr. Tortolani, 01:55)

• Highlight: This year, 1,400 U.S. medical students wanted to pursue anesthesia but there were not enough positions.
• Projection: Anticipates a gap of 5,000–6,000 anesthesiologists nationwide in a decade.
• Short-term Fix: Nurse anesthetists handling more cases with anesthesiologist oversight, especially in ASCs.

2. Decreasing Hospital Profit Margins (03:02)

“To grow hospitals you need to have a profit margin... what's happening today in medicine, with the limitations in Medicare, Medicaid and the introduction of AI into medicine... is going to increase the cost. And I don't know how we can increase costs unless we increase profit margins.”
(Dr. Tortolani, 03:10)

• Margins are essential for growth and reinvestment, not excess profit.
• Cites limited government reimbursement and rising expenses (like AI tech) as key pressure points.

3. Expansion of For-Profit Organizations in Medicine (03:34)

“The invasion of for-profit organizations into medicine whose primary concern is not patient care, but... making profit for the equity holders in that company.”
(Dr. Tortolani, 03:38)

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Excitement About AI and Clinical Advances

AI’s Transformative Power (04:47–08:19)

• AI rapidly reshaping:
  • Administrative functions
  • Basic scientific research (especially at cellular and subcellular levels)
  • Clinical diagnosis and image analysis (radiology, pathology)
• Major Clinical Impact:

“AI is allowing us to make the diagnosis that much earlier, which means we don't need to do so much invasive surgery. The surgery will be less and less invasive.”
(Dr. Tortolani, 08:19)

• Moves medicine toward:

  • Generative care: classic bedside clinical care
  • Precision medicine: using cellular/subcellular data for earlier diagnosis and targeted treatment, especially in cancer and heart disease
  • Personal care: tailoring therapies to individuals, not just the diagnosis

• Connection to ASC Growth:

  • Earlier diagnosis reduces need for open surgery, drives minimally invasive procedures in ASC settings.

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Outlook on Growth in Next 12 Months

Cardiology and Outpatient Trend (08:56–12:45)

• Cardiac therapeutics increasingly shifting to the outpatient/ASC setting (TAVRs, stenting, pacemakers, defibrillators, diagnostic catheters).
• More chemotherapy, GI, and pulmonary therapy done outside the hospital.
• Prediction: Fewer hospital beds needed; hospital ORs must be “backfilled” with more acute/well-suited cases.

“I think we will be filling the ACSS more and more with all sorts of therapy and diagnostic procedures.”
(Dr. Tortolani, 09:11)

• Market Dynamics:

  • Academic medical centers/hospital systems growing rapidly.
  • Standalone hospitals in underserved/poverty areas struggle to keep pace.
  • Speculates that independent hospitals may be absorbed into larger systems over time.
  • Ownership/partnership trends: physicians may become partners, not just employees, in health system ASCs.

• Profit Margin Warning:

“Their profit margin is being low, really reduced. And that's a real concern... They take their profit and build. They don't put it in their pocket. They build inventory care centers and they build cancer perfusion centers and things like that. So I think they're doing the right thing. But how to do it is going to take a lot of cooperation.”
(Dr. Tortolani, 11:41)

• Leadership Needs: Coordination between strategic and tactical planners is vital for success.

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Persistent Gaps in Rural and Underserved Areas

Barriers to Cardiology and Quality Care (13:04)

“If you're in a rural community, all the things we just talked about does not very much reach the people. Our patients in rural communities in 50% of the rural counties in this country don't have a cardiologist... The level of care of those patients is not the same as the level of care in the major medical centers, but not even close, for obvious reasons.”
(Dr. Tortolani, 13:04, 13:38)

• 50% of rural U.S. counties lack any cardiologist; travel times can exceed 45 minutes.
• Financial losses at safety-net hospitals—sometimes losing over $100 million/year—impede their ability to deliver high-quality care.

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Memorable Quotes and Moments

• On AI’s Clinical Promise:

“AI is allowing us to make the diagnosis that much earlier, which means we don't need to do so much invasive surgery. The surgery will be less and less invasive.”
(Dr. Tortolani, 08:19)

• On Systemic Change:

“We're in tremendous change in medicine. And my biggest concern is what I hear. The major successful hospital systems... their profit margin is being low, really reduced. And that's a real concern to me because they take their profit and build.”
(Dr. Tortolani, 11:29)

• On Equity:

“It's very hard to get those people the kind of care that other people get. It's not equal, definitely.”
(Dr. Tortolani, 13:53)

• On Optimism Despite Challenges:

“I don't mean to be pessimistic, because I look at the advances and I say, my God, it's unbelievable. It's truly unbelievable what's happening, I think how to coordinate it and do it right so everybody benefits by it. That's going to take a lot of thinking and planning, but we certainly are making advances on the scientific side of it. Without a doubt. Absolutely.”
(Dr. Tortolani, 14:52)

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Timestamps for Important Segments

• 00:31 – Dr. Tortolani describes his background in surgery and ASC development
• 01:48 – Three major healthcare trends: workforce shortages, hospital profit margin decline, rise of for-profit organizations
• 04:47 – Excitement about AI’s administrative and clinical impact
• 08:19 – AI meaning earlier, less invasive diagnoses
• 08:56 – Growing cardiac & therapeutic procedures in ASCs; shifting care models
• 13:04 – Rural and underserved communities—persistent gaps in access and care
• 14:52 – Staying optimistic about progress in the face of systemic challenges

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Conclusion

Dr. Tortolani’s conversation is both a warning and a celebration. He underscores serious staffing shortages, economic headwinds, and access inequities, while passionately highlighting science and technology advances—especially AI’s revolutionary effects on research, diagnosis, and patient-centered care. The landscape for ambulatory cardiac care and ASCs is evolving rapidly, but ensuring equitable access and sustainable growth will require smart, coordinated planning and continued innovation.

Transcript

[A]

Hello, this is Francesca Matthews with the Becker's ASC Review podcast. I'm thrilled to be joined today by Dr. Anthony Tortolani, a cardiac and thoracic surgeon and professor emeritus in clinical cardiothoracic surgery at Weill Cornell Medical College. Dr. Tortolani, thank you so much for being here today.

[B]

My pleasure. Hopefully it will be assistant you.

[A]

Well, great. To start us off, could you please introduce yourself and tell us a little bit about your background?

[B]

I am an emeritus professor. I spent almost all my career either as chief of cardiothoracic surgery or as chairman at different hospitals, almost all within the Cornell network. And I was involved with building the first ambulatory surgery center at Northwell. I was involved with building the ambulance when we converted a floor at New York Presbyterian Hospital to ambulatory surgery. And in the building of the ambulatory surgery center, which included cardiology at Methodist Hospital, which was a hospital that joined our network. And finally at a safety net hospital, I was part of strategic planning that decided committee which decided not to build a victory surgery center because they didn't have the funds nor the patient population to support it. So I have a lot of experience in developing and running up ambulatory surgery centers.

[A]

Gotcha. So quite a wealth of experience there. What are the top three trends that you're following in healthcare today?

[B]

Well, I, and this was discussed in some detail at the annual meeting. The great concern about not having enough caregivers, primarily anesthesiologists, nurses and anesthesia assistants. That is a real problem that's going to get worse over the next seven or eight, 10 years unless we increase the number of anesthesiologists for training. This year there are 1,400 medical students interested in going into anesthesia in this country and we had no positions for them. And they expect within the next 10 years we're going to be short about 36. 36, I'm sorry, no, about 5 or 6,000 anesthesiologists across this whole country. So we're looking at a major problem. I think the important thing is much of the anesthesia that's provided in ambulatory surgery can be provided for by nurse anesthetists at the head of the bed with anesthesia. Anesthesiologists in close proximity, I think. So that will be the short term solution, but I think that's a trend that we have to fix. I think the second trend is a decrease in profit margin at hospitals. I don't mean that hospitals are making money to put money in people's pockets. I mean that to grow hospitals you need to have a profit margin to build buildings and develop programs. And what's happening today in medicine, with the limitations in Medicare, Medicaid and the introduction of AI into medicine, which I'll talk about in a few minutes, is going to increase the cost. And I don't know how we can increase costs unless we increase profit margins, which at least in the major medical centers in New York is not happening. So that's a trend I'm concerned about. And the third trend is the invasion of for profit organizations into medicine whose primary concern is not patient care, but its primary concern is making profit for the equity holders in that company. So I think those are the overall major concerns that I have or the three trends I see about medicine, but not actually within the practice of it. Those are the outside concerns that I see.

[A]

Absolutely. And that all definitely resonates with the folks I speak to over here at Becker's every day and just some of the conversations that I've been having. What are you most excited about right now in healthcare overall or in the ASC space specifically?

[B]

Either. Well, I think if you keep in mind my concerns, I think what's really exciting is the involvement in artificial intelligence in medicine. And I think it can be very important. And I think it's obvious that it's going to be important in the administrative, the supply chain and the. Administrative hierarchy and organization within, within, within medicine. But I think what's exciting to me is not the business side of it, but the tremendous, tremendous influence they're having in basic science research. It's unbelievably important. Their role in basic science research at the cellular and subcellular levels, which is being directly applied into clinical care. Their import in there, they can help us do massive research. And it's ongoing at the present time. I'm not talking about six months or 10 years ago. I'm talking about now, today, yesterday. If you look at the Journal of Nature, which is the foremost journal in the world, or Nature Medicine, what AI is doing to help us do research is unbelievable. But I think it also is really important in the application in clinical medicine. And there it's helping us, it's helping radiologists to read X rays and pet scans and MRIs more accurately. And at the cellular level, we, which we've never been able to do before. So I think that's happening which makes us able to diagnose the diseases much earlier at a time when it's curative with minimal invasive therapy, with less surgery, meaning more cases being done in ambulatory surgery by coincidence. So I think it's the great. And it's also been assisting us in clinical decision making. So it was written recently that we're going to go from generative care, which we're doing now. Somebody's at the bedside looking at the patient, looking at the X rays, looking at the blood work and making decisions, to precision medicine, which is diagnosis made at the cellular and subcellular level, which makes it much earlier in the disease process, which increases the chances of cure, especially in cancer or heart disease. And finally, it will help in applying to a degree, surgery to the care and decision making. So we're gonna go from generative to precision to personal care, where the care will be for the individual, not for the people who have lung cancer, but to that particular individual and that individual's particular cancer problem. So I'm very excited about that. Really excited about it.

[A]

Yeah, absolutely. The advancements that AI is bringing to research and to diagnose these are incredible. I feel like I read a new stunning headline every day.

[B]

Let's just add to that for a second, because I said it, but I maybe didn't say it. Clearly, AI is allowing us to make the diagnosis that much earlier, which means we don't need to do so much invasive surgery. The surgery will be less and less invasive.

[A]

Yeah, no, and I know that's, you know, just there's huge implications there for the overall, like, efficiencies and cost and experience of everything we know about healthcare. So. Yeah, and kind of moving to a different, different area here. But how are you thinking about growth over the next 12 months?

[B]

I think that with the growth in cardiology in an outpatient facility is going to continue to grow more and more cardiac therapeutic. Invasive cardiac therapeutics will not be done by surgeons, but would be done by cardiologists or cardiologists with surgeons in an outpatient theater, like the Tavrs, for instance, and stenting and pacemakers and AICDs and diagnostic insertion of diagnostic catheters, which will defibrillate patients at home. So I think we will be filling the ACSS more and more with all sorts of therapy and diagnostic procedures. I think the critical thing is to be able to backfill the ORs and hospitals with appropriate cases so they can continue to be successful and take care of a different type of patient. I think we're going to need less hospital beds. More chemotherapy is being done on the outpatient basis. You're not going into the hospital to get chemotherapy. And certainly in cardiology and pulmonary in gi, More and more of that's done in ambulatory surgery or ambulatory cancer or pulmonary labs. So it's truly a time of great change. And I think the key thing is for the large academic medical centers and the hospital systems, which is, at least in New York, it's growing. Those programs are growing tremendously. The independent hospitals disappearing, except in the areas of poverty and the underserved, where their care is not at the same level as in the big systems. The big systems, they're not going in to the poor communities and taking over those small, inadequate hospitals. That's a real problem. But I think over time they will be incorporated into the big systems. It's not today or tomorrow. And I think to do that, you need physicians that have to be dedicated to those systems. They have to be part of the large systems, either as employees, which has been that way, or even maybe I'm reading about where they're being partners, the partners with large health systems and ownership of ambulatory surgery centers. And I think that's another way of doing it. But I think all we're in tremendous change in medicine. And my biggest concern is what I hear. The major successful hospital systems in a greater New York area, some of them are expanding into Connecticut and upstate New York, but I also see that their profit margin is being low, really reduced. And that's a real concern to me because they take their profit and build. They don't put it in their pocket. They build inventory care centers and they build cancer perfusion centers and things like that. So I think they're doing the right thing. But how to do it is going to take a lot of cooperation. And I think the. Without getting too much into this, I think the strategic planners and the people who carry out the tactical planners, the strategic and tactical planners have to come together and be unified. Not that they do the same job, but they have to be coordinated.

[A]

Absolutely. Everything you said, especially about the new kind of cardiovascular codes that are being approved for the ASC setting, is definitely kind of huge buzz in the industry right now. So I think a lot of people are thinking about growth in the similar way that you. Is there anything that I haven't asked you about that you feel like is important in this conversation?

[B]

The only thing I would say is that if you're in a rural community, all the things we just talked about does not very much reach the people. Our patients in rural communities in 50% of the rural counties in this country don't have a cardiologist. And to get to a cardiologist, takes them 45 to 50 minutes of a car ride. So it's hard for those people to get care. And certainly having worked in Manhattan, in the inner city and in boroughs as well, I see that the level of care of those patients is not the same as the level of care in the major medical centers, but not even close, for obvious reasons. I don't blame the caregivers there. It's just that they can't. They don't have any profit margin. They lose millions and millions and million 50, $100 million a year taking care of the indigent with funds that come from the States. So it's very hard to get those people the kind of care that other people get. It's not equal, definitely.

[A]

No. And it's something I think about a lot as well, having come from more of a public health reporting background myself. And just we talk about the, you know, these advance. I know that, you know, the intersection of what we were talking about earlier, AI and cardiology, there's, you know, tons of advancements as far as the, the level of care that can be provided in that field and what's possible now with the emerging technology. And it's. It's pretty stark to read about some of those things and to also read about, you know, the cases that you're describing of, you know, counties where there's no cardiovascular care whatsoever. So there's definitely some major gaps to close within. Within the space.

[B]

There is. But, you know, I don't mean to be pessimistic, because I look at the advances and I say, my God, it's unbelievable. It's truly unbelievable what's happening, I think how to coordinate it and do it right so everybody benefits by it. That's going to take a lot of thinking and planning, but we certainly are making advances on the scientific side of it. Without a doubt. Absolutely.

[A]

And I think, you know, the rest is happening in conversations and sort of brainstorming and sharing ideas, just like we are today. So, you know, on that note, that is all I had for you today. Dr. Tortolani, thank you so much for joining us.

[B]

Okay. I hope it's helpful and thank you for having me. I appreciate it.

[A]

Yeah, thank you. It's been a pleasure. And I look forward to connecting with you again in the future.

[B]

Sam.